Initial onboarding will take place at our offices in Colchester, VT. The position will then be a hybrid work arrangement with 1-2 days per week in our offices located in Colchester, VT. In-person meetings are also required at least quarterly.

Job Summary

The Clinical RN Auditor is responsible for ensuring clinical documentation meets regulatory standards and procedures. This role involves reviewing potential quality of care issues, understanding workflows, and establishing patient care plans to support technical and clinical requirements. The auditor works to improve clinical outcomes by monitoring documentation accuracy and consistency, reducing risk, evaluating data, and collaborating with the manager of clinical outcomes to provide expertise in coding classifications.

Qualifications / Job Requirements

Education and Licensure

• Current unencumbered Vermont RN Licensure
• Homecare Coding Specialist- Diagnosis, or ability to obtain within one year from hire and maintained throughout employment
• Homecare Coding Specialist- OASIS, or ability to obtain within one year from hire and maintain throughout employment
• Associates Degree required, Bachelor’s degree preferred
  
  

Expected Experience/Skills/Attributes

• 3-5 Years of Home Health or Hospice experience; or a combination of education and experience from which comparable knowledge was obtained
• Prior ICD-10 and other medical coding experience preferred
• OASIS and HIS experience highly preferred
• Proficiency in medical and clinical terminology
• Demonstrated Proficiency in EMR (EHR) technology
• Strong interpersonal and communication skills, with the ability to build and maintain relationships with diverse groups of people.
• Excellent organizational and time management abilities
• Meticulous and exacting attention to detail and trend identification
• Strong project management abilities
  
  

Success Criteria

• Quality Orientation – Comprehends and can explain technical and professional terminology, applies these skills appropriately and leverages these skills to solve difficult issues and identify opportunities for improvement to ensure accuracy and optimal outcomes.
• Applied Reasoning – Leverage facts, data, and ideas to understand identifying interconnections and relevant themes; identifies underlying cause-and-effect relationships that may drive multiple, seemingly unrelated, outcomes.
• High-Impact Communication – Conveys a professional presence in communication; clearly and succinctly conveying information and ideas. Checks understanding with audience adjusting message as necessary to ensure full comprehension.
• Authenticity – Adheres to moral, ethical, and professional standards, regulations, and organizational policies; keeps commitments to promised actions.
• Adaptability - Maintaining effectiveness when experiencing major changes in work responsibilities or environment (e.g., people, processes, structure, or culture); adjusting effectively to change by exploring the benefits, trying new approaches, and collaborating with others to make the change successful.
  
  

General Standards

• Must demonstrate and maintain any required competency
• Able to speak, read and write in English
• Be honest, self-directed, possess initiative, display good judgment and a positive attitude toward daily activities
• Have the ability to communicate clearly and effectively both orally and in written work
• Be able to work cooperatively and in a productive manner with organization’s employees, clients, customers and the general public
• Maintain satisfactory standing with the Adult Abuse Registry, Child Abuse & Neglect Registry, Vermont Criminal Information Center and OIG
• Be free from intoxicating or impairing effects of drugs, prescribed or otherwise, in the workplace
• Be free from the use of alcohol during work shifts
• Be able to conduct the functions of this job without risk of harm to the health and safety of self and others
• Hold a valid driver’s license and have a reliable, registered vehicle with insurance as required by the organization, and appropriate to position
  
  

Responsibilities

• Conduct thorough audits of patient episodes of care, ensuring accurate documentation that meets Medicare Conditions of Participation while validating compliance with standards for all billing requirements. This includes identifying documentation inconsistencies and identifying opportunities for improved efficiency and accuracy.
• Applies knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis codes and makes corrections while collaborating with stakeholders and reference tools. This includes seeking clarification from clinicians, physicians and others as needed to complete coding and OASIS reviews and initiating physician coding queries.
• Supports monitoring of outcomes data, to ensure clinical proficiency maximizing outcomes and collaborates with the manager of clinical outcomes to provide remediation as needed. Analyze data to identify trends and opportunities for organizational accuracy and effectiveness.
• Collaborate with manager and organizational stakeholders in order to maximize organizational reimbursement through ensuring the highest standard of quality and value-driven patient care.
• Completes all duties also associated with Clinical Coder/Auditor roles which do not require an RN Licensure.
  
  

Professional Accountability

• Demonstrates a commitment to the mission and values of the organization
• Complies with all organization policies and procedures
• Demonstrates respectful and effective communication in all interactions
• Protects the privacy and confidentiality of clients, co-workers and organization’s operations
• Complies with organization’s policies to protect confidentiality, integrity, availability and security of all protected health information
• Conducts themself in a safe manner by adhering to all safety practices, rules and standards
• Demonstrates a commitment to quality and proactively seeks to make improvements to systems and processes
• Reports to work on time, provides advance notice for time off, accurately reports time and attendance and appropriately manages paid time off (if applicable) in accordance with organization’s policy
• Demonstrates a commitment to integrity in work habits and use of organization’s resources
• Performs duties as assigned that may be outside principle responsibilities
• Meets own learning needs. Participates in educational programs of the organization, including completion of all mandatory competencies, education or training
• Effectively communicates to transfer information, provide guidance and resolve conflicts
• Reports concerns and complaints regarding abuse, neglect and exploitation in accordance with Vermont State Law and the organization
• Enhance or improve organization’s services by participating in team meetings, projects and committees
• Contributes to a positive work environment and responds in a constructive manner to change
• Documents the provision care and services in accordance with organization’s policy
  
  

Work Conditions

• 1. Traveling may be required
• 2. May be asked to work during non-business hours
• 4. May experience:
• Stress due to a demanding profession.
• Extended periods of time working with computers
  
  

Essential Physical Requirements

• 1. Must walk, sit, stand, bend, lift and move intermittently during working hours
• 2. Must have the ability to push, pull and lift from the floor, up to a total of 50 pounds and be able to move with the weight, as to organization’s standards
• 3. Climbing-be able to navigate stairs of varying heights and degrees
• 4. Balancing-be able to maintain balance
• 5. Kneeling, crouching, stooping, twisting, reaching below waist level, reaching overhead and reaching torso level
• 6. Manual finger dexterity-will need dexterity to perform duties and use equipment
• 7. Visual acuity-will need sufficient eyesight to drive a car, use office equipment and perform duties
• 8. Auditory acuity- will need to assist individuals in person and by telephone